Background and Methodology

Background

The overall purpose of the program reviews is to provide a regular and transparent format
to monitor, assess, diagnose, and address policy issues in each major program area within DHCF . The preparation of these reviews is designed to serve as the basis for DHCF budget initiatives
on an ongoing basis.

This will provide a concrete mechanism for
professional Medicaid staff within the DHCF to recommend new policies that improve the program
so that well-founded, data-driven, and operationally sound proposals may be advanced to the DHCF board, the Governor, and the Legislature. Publication of these reviews provides accountability
and a record of progress in managing the programs under DHCF 's umbrella. It also serves as a central source of plain-language
program information, and creates a transparent means to describe and share DHCF policies
and plans with participants, providers, and policymakers.

Feedback from readers and those
who make use of the reviews’ conclusions and recommendations will be an important checkpoint
for DHCF staff, and will enhance the quality of DHCF ’s management of the Medicaid program.

Methodology

The basic approach in completing each program review is to describe each program in detail, describe
the population that each program area serves, and highlight key trends in spending, utilization
of services, and, where available, the quality or effective delivery of service. In many cases,
these descriptions represent the creation of the first (known) resource for a plain-language explanation
of the program component. Program managers also included descriptions of significant
programmatic activity in each area. The types of questions to be addressed in each review include:

What are the trends in spending, utilization, and quality?

Why have expenditures increased/decreased/remained constant?

What program changes have been implemented and how have they affected spending, participation,
and utilization?

Are these trends consistent with trends in the health care marketplace?

What program improvements does the analysis suggest?

What are the opportunities for potential savings in each area?

What gaps in service, payment, or other policies exist in the program area?

What questions will remain unanswered that may be addressed in future years, or
with additional data?

In many reviews, there are additional analyses, or gaps in available data, that would have supported
a more complete explanation of program trends. However, all of the reviews establish an
important baseline for routine evaluation and cyclical improvement in the program areas. The
agency’s strategic plan includes a focus on developing agency capacity in data collection and
analysis which is designed, in part, to support more complete evaluation of DHCF ’s programs.

Nevertheless, this process hasidentified a number of meaningful program improvements that
will generate both savings and improved quality of service.

Engaging in this annual evaluation and laying out for public scrutiny the policies and plans for each
area of DHCF ’s programs and operations should both accelerate and better inform program improvements.
The process is DHCF ’s effort to implement transparent, data-driven policies throughout
its public health insurance programs, and represents a significant advance in participatory
public policy-making. The transformation is to the policy process itself, using data and
transparent goals to motivate program improvements and avoid speculative change based on anecdote.